Fred Baughman, MD 7 31 03]

Lana wrote:

>  So "being bored" is now a sign of depression...
>  The behavioral problems they cause, such as aggressiveness,
>  withdrawal or uncontrollable tantrums, can result in a child being
>  labeled a problem not only by day care or school officials, but by their
>  peers. Once those labels are established, they can be difficult to
>  remove, and they can reinforce the child's emotional problem.   
> 
>  How about pointing out that once psychiatric labels are established,
>  they are IMPOSSIBLE to remove?
 
  http://abcnews.go.com/sections/us/Living/child_psychology030731.html

  Kids on the Couch
  Doctors Say 1 in 10 Children Suffer Emotional, Mental Disorders
 
  By Dean Schabner
 
  July 31- When Monica was told she should consider taking her 2-year-old
  son to a psychiatrist, her first reaction was that maybe her
  pediatrician was the one in need of a shrink.
 
  Thirty years ago, most psychiatrists would have agreed with her, but
  times change.
 
  According to the Office of the Surgeon General, one in 10 children under
  the age of 18 "suffer from mental illness severe enough to cause some
  level of impairment."
 
  The National Institute of Mental Health, in its fact sheet for
  physicians Depression in Children and Adolescents, cited studies that
  found as many as 2.5 percent of children and 8.3 percent of teenagers
  suffer from depression.
 
  Some psychiatrists say those numbers may even be conservative,
  suggesting that as many as one in five children will go through extended
  periods when they show the symptoms of significant emotional problems by
  the time they turn 18.
 
  And those periods can begin surprisingly early, some psychiatrists say.
 
  The subject is still controversial, but most child psychiatrists
  ABCNEWS.com talked to agreed that at least some precursors of serious
  depression can appear in children as young as 2 years old. Some said
  that children that young can in fact suffer from full-blown depression
  or post-traumatic stress disorder.
 
  "Over the past 30 years there's been a general movement towards
  recognizing that children can suffer from serious psychiatric
  illnesses," said Dr. Jay Reeve, a clinical psychologist with 17 years
  experience who is currently the senior psychologist on the Children's
  Inpatient Unit at Bradley Hospital, a pediatric psychiatric hospital in
  East Providence, R.I.
 
  He said it shouldn't really come as a surprise that children are
  vulnerable to emotional problems as serious as adults, because children
  have so little control over the world they live in, and especially when
  they are very young and cannot really understand why things happen.
 
  "You've got a person 2 feet tall and vulnerable to anything the big
  people want to do," he said. "We see kids who are suffering from pretty
  clear signs of depression every day. I think you're seeing professionals
  and society becoming more comfortable with saying that kids suffer from
  these illnesses."
 
  While some psychiatrists said that factors such as the rising number of
  families in which both parents work, violence in neighborhoods and the
  mobility of families may all have contributed over recent decades to
  more instability in young childrens' lives that in some cases might
  result in serious emotional problems, most said they do not believe that
  there has been any real growth in the number of children who suffer
  these problems.
 
  Instead, it is that growing "comfort" with making the diagnosis that
  accounts for what seems like an increase in the number of disturbed kids
  in America, they say.
 
  As with some types of cancer, it may not be that there is a rise in the
  number of children affected, only an increase in the ability to
  recognize it and call it by its proper name, said Neal Ryan, a professor
  of child and adolescent psychology at the University of Pittsburgh who
  specializes in depression and anxiety disorders.
 
  Searching for an Answer
 
  For Monica, "comfortable" may not be the word to describe how she feels
  about saying her 2-year-old could need a psychiatrist, but when she and
  her husband considered the alternative, they realized they had to try
  anything they could.
 
  They decided they could not let their son go on with behavioral problems
  that include uncontrollable tantrums when he is anywhere with more than
  just a few people, refusal to interact at all with other children,
  wearing socks on his hands and a period of eight months when they could
  not take him out of the house at all because of the tantrums he threw.
 
  Still, she said she has a hard time imagining how a psychiatrist is
  going to be able to learn anything from her son, much less begin to help
  him.
 
  "He's talking, but they can't talk to him the way they would talk to me,
  so I'm wondering how this is going to work," she said. "I personally
  think that he is very young to go to a psychiatrist, but we have tried
  every other avenue for help."
 
  Psychiatrists do not expect to be able to speak to a child the way they
  can speak to an adult, though, and have developed different strategies
  to try to understand the nature of a youngster's problem.
 
  The difficulty is not as pronounced with teenagers, but with elementary
  school age children, language is not always the best way into a
  youngster's thoughts and feelings, psychiatrists say, and with toddlers,
  simply talking reveals very little.
 
  "Certainly we don't have them lay on the couch and tell us about their
  dreams," said Dr. Chistopher Peterson, an assistant professor in
  psychology at Penn State Hershey Medical Center.
 
  From Skeptic to Advocate
 
  One alternative is play therapy, in which a therapist allows the child
  to play - either with the therapist involved or with the therapist
  simply as an observer. Either way, the therapist watches the kind of
  games chosen, the story lines, what happens, and over a period of time
  is able to draw conclusions from the patterns that emerge from the
  games.
 
  "I sat in on the first few sessions and was able to see how it worked,"
  said Rachel, a woman whose adopted daughter has been diagnosed with
  post-traumatic stress disorder. "The therapist had so much insight into
  things I would have overlooked, how she would play with her dolls. Most
  of it is free play, but there is tremendous observation by the
  therapist, identifying emotions."
 
  She said that in the program her daughter is in, the therapists also
  meet with the childrens' parents weekly to discuss what happens in the
  home, asking probing questions about the child's behavior and
  interactions with others.
 
  It has made a difference, at least for her daughter.
 
  "I'm now an advocate," she said.
 
  More Than the 'Terrible Twos'
 
  Like most parents who fear their child may have an emotional or mental
  disorder that requires psychiatric care, Rachel did not immediately find
  doctors who seemed to understand what was going on.
 
  The first step was finding someone who recognized that what the little
  girl was suffering was more than the "terrible twos." It was when she
  had a developmental evaluation of the girl done that she first heard
  about post-traumatic stress disorder, but even then, the answer offered
  wasn't the one she was looking for.
 
  "They told me, 'We can medicate her if it would make it easier for
  you,'" she said. "I can't tell you how insulting that is to me, that a
  doctor could suggest or that a parent could medicate a child just to
  make it easier for them. That was a frightening idea. And it was never
  presented that that would help her."
 
  The doctors that ABCNEWS spoke to all said that medications should only
  be used to help the child, and should only be used in conjunction with a
  program of therapy.
 
  "What I believe the best meds medications are is strong relationships
  in your life, with your family and your friends and strong confidence in
  yourself and your ability to do things well," said Dr. John Sargent,
  professor of psychiatry and pediatrics at the Baylor College of Medicine
  and director of child and adolescent psychiatry at the Ben Taub Hospital
  in Houston. "So what I want to do is use my meds to make those meds
  work."
 
  Changing the Chemistry
 
  Medications are a sore issue with many families, who believe that their
  children have been unfairly labeled as suffering from attention
  deficit/hyperactivity disorder and are required by school districts or
  day care providers to take drugs such as Ritalin.
 
  Studies - Reeve called them "voluminous" - have shown that if a child is
  properly diagnosed with ADHD, certain medications can help the child not
  only learn while under the effects of the drug, but also learn to focus
  so that he can eventually study and succeed without the drug.
 
  The same is true for some medications for depression and other emotional
  disorders that can affect children, psychiatrists say.
 
  Especially among young children, a large contributing factor to
  depression can be heredity, meaning that their condition may begin in
  their brain chemistry, and medications known as selective serotonin
  reuptake inhibitors work to change brain chemistry.
 
  But medications are not the only way to make these changes.<.
 
  "Psychotherapy can adjust the biochemistry as well," Reeve said.
 
  A 'Stage' or Something More?
 
  Proper diagnosis and treatment are both extremely problematic when it
  comes to young children, psychiatrists say.
 
  The problem goes back to what Reeve said: That until recently it was not
  accepted that very young children could suffer such problems, and while
  more and more psychologists and psychiatrists may now take childhood
  mental and emotional disorders seriously, they say that too many primary
  care physicians are not trained to recognize the symptoms.
 
  "Unfortunately, a lot of primary care professionals will be inclined to
  put parents off with 'they'll grow out of it,'" Peterson said.
 
  Sargent said that he gives most "stages" a child might be said to be
  going through a month.
 
  "But if a kid is alienating friends, you don't want that going on more
  than a month," he said. "If his grades are dropping, you don't want that
  going on for more than a month or two. I would say to a kid, 'Hey, let's
  get back involved in things,' and if that works, fine. If it doesn't,
  then I want people to come get some help. Then you eliminate some of the
  lifetime problems that can result from this."
 
  If a child has a serious problem, whether it is depression, PTSD,
  bipolar disorder or any other mental or emotional illness, getting the
  proper treatment can mean getting them back on track for a normal life,
  he said.
 
  "I would much rather treat a problem in a 3-, 4- or 5-year-old in the
  first six months of it starting, rather than in a 13- or 14-year-old,
  when it's been around for 10 years," he said. "A lot of problems that
  kids face we can prevent if we can start treatment early."
 
  Devastating Effects
 
  Because these problems manifest themselves in so many different ways,
  their effect on a youngster can be devastating, psychiatrists say.
 
  The behavioral problems they cause, such as aggressiveness, withdrawal
  or uncontrollable tantrums, can result in a child being labeled a
  problem not only by day care or school officials, but by their peers.
  Once those labels are established, they can be difficult to remove, and
  they can reinforce the child's emotional problem.
 
  They can also result in eating and sleeping disorders that can stunt
  physical and mental development, putting them out of step with their
  peers.
 
  "To be diagnosable, you can't just have symptoms, you have to have
  trouble functioning in your life," Sargent said. "The symptoms create
  difficulties that worsen the problem."
 
  Treatments may vary from child to child, depending on his or her
  individual problem and situation, but psychiatrists agree that there is
  one constant - the whole family must be involved.
 
  Signs of Depression in Children
 
 
  July 31 - Many of the symptoms of major depressive disorders are common
  to adults, teenagers and children, but there are others that
  psychiatrists say are associated specifically with the condition in
  teenagers and children, according to the National Institute of Mental
  Health.
  Those symptoms that are seen in people of all ages are:
 
    Persistent sad or irritable mood;
 
     Loss of interest in activities once enjoyed;
 
     Significant change in appetite or body weight;
 
     Difficulty sleeping or oversleeping;
 
     Psychomotor agitation or retardation;
 
     Loss of energy;
 
     Feelings of worthlessness or inappropriate guilt;
 
     Difficulty concentrating;
 
     Recurrent thoughts of death or suicide.
 
  The following list of symptoms are signs of depression in children and
  adolescents under age 18.
 
     Frequent vague, non-specific physical complaints such as headaches,
  muscle aches, stomachaches or tiredness;
 
     Frequent absences from school or poor performance in school;
 
     Talk of or efforts to run away from home;
 
     Outbursts of shouting, complaining, unexplained irritability, or
  crying;
 
     Being bored;
 
     Lack of interest in playing with friends;
 
     Alcohol or substance abuse;
 
     Social isolation, poor communication;
 
     Fear of death;
 
     Extreme sensitivity to rejection or failure;
 
     Increased irritability, anger, or hostility;
 
     Reckless behavior;
 
     Difficulty with relationships.
 
  None of the above symptoms alone are enough to indicate major depressive
  disorder. The NIMH says that five or more of those symptoms must persist
  for at least two weeks before a diagnosis of major depression is
  indicated.
 
 
  - By ABCNEWS